2 to 3 months after a stroke is the best time for rehabilitation
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Stroke victims tend to have greater hand and arm function when intensive rehabilitation begins two to three months after their injury.
The brain's greatest ability to rewire itself is at this "critical time," according to 72 stroke victims, as a team reported in the journal PNAS.
This finding challenges the current practice to start rehabilitation as soon after a stroke as possible. It suggests that intensive rehabilitation should be continued for longer periods than most insurance covers allow, according to Elissa Newport (co-author of this study and director, Center for Brain Plasticity and Recovery, Georgetown University Medical Center).
Newport points out that people can be at home for up to three months following a stroke. "That is not the time most people are receiving their rehabilitation."
Newport spoke in the place of Dr. Alexander Dromerick who died before the study was published.
The results of the larger studies will confirm the findings, according to Li-Ru Zhao, a professor in neurosurgery at Upstate Medical University, Syracuse, N.Y. She was not part of the research.
Patients treated at Medstar National Rehabilitation Hospital in Washington, D.C. were included in the study. Most of them were in their 50s or 60s. Anthony McEachern was one of the participants in the study. He was 45 at the time he suffered a stroke in 2017.
"My ability of moving was decreasing in front of me"
McEachern was just hours away from imitating Michael Jackson's dance moves with his children. McEachern was unable to stand that night at home.
McEachern says, "My ability to move was decreasing in front of me," and is now a professor of visual and performance arts at North Carolina Agricultural and Technical State University.
McEachern spent more than a year in rehabilitation after his stroke. He was treated in hospital for a week. Slowly, he was able to walk again. However, he was still unable to walk after returning home.
He says, "Normally I can jump in the bath and within 20 minutes I'm dry and dressed." It took him two hours to recover from the stroke.
This study was inspired in part by research that had been done on animals recovering from strokes.
Newport states that if rehabilitation is started too quickly, it can make a stroke worse. You had very good results if rehab therapy was delayed for a short time. Then, as you were further away from the stroke, you lost any success.
Participants in the stroke study were randomly allocated to receive 20 hours of additional intensive training. The training began within one of three times periods: 30 to 60 days after the event; 60 to 90 days later; or six months later. Training might include reaching and grasping exercises. Each patient will receive a customized training program.
The critical period of optimal recovery
Newport states, "What we discovered is that the best recovery was for those who received intensive training two to three months after stroke," Newport adds.
She points out that the treatment is not a panacea. She says that there is an improvement in reaching and grasping tasks, but not enough to fully recover.
McEachern began intensive training before the optimal time. McEachern believes that the intensity of the therapy helped him regain some control over his right hand.
"I can hold a toothbrush. I can hold bottles. He says that he can hold the bottle with one hand and open it with the other. "It was impossible to do any of these things immediately after the stroke, and it is probably impossible for me to imagine doing them."
According to brain scientists, the findings of this study are likely to spark a new round in debates about when stroke patients should begin intensive rehabilitation.
Zhao states that the study is a good starting point to determine when intensive motor training should be started. However, the study was small and focused on one treatment center.
Dr. JinMoo Lee, chair in neurology at Washington University, St. Louis, says that the idea that the brain can recover most quickly is "something we've known all along, based upon the animal models." "But this is the first evidence from humans that rehab therapies can be most effective in improving recovery.
Lee says that the brain goes into survival mode immediately after a stroke. It is trying to clean up any injuries. The brain eventually enters an interim phase in which the injury becomes gradually a scar.
He says, "And probably in that interim period there are also some changes that allow for the brain to become less plastic." He describes this period as a little like early childhood when the brain can learn and rewire very quickly.
